What are Epidural Steroid Injections?
Steroid injections are not new. The first use of spinal injections to treat low back pain was documented in 1901, and in 1952, epidural steroid injections were used to treat low back pain with associated sciatica (pain in the sciatic nerve due to lumbar disc herniation). Today, epidural steroid injections have become an integral part of non-surgical management of low back pain.
An epidural injection is typically used to alleviate low back and/or leg pain. While the effects of the injection can be temporary (providing relief from pain for one week up to one year), an epidural can be very beneficial for patients during an episode of severe back pain. Importantly, it can provide sufficient pain relief to allow the patient to progress with his or her rehabilitation program.
An epidural is effective in significantly reducing pain for approximately 75 percent of patients. It works by delivering steroids directly to the painful area to help decrease inflammation. There is also research that shows there is a flushing effect from the injection that helps remove inflammatory proteins from around the structures that may cause pain.
When do specialists recommend spine injections?
Epidural steroid injections for rehabilitation
In general, an epidural steroid injection is used to help provide pain relief to enable patients to progress with their rehabilitation. Individuals who have less back pain and feel more comfortable are generally able to work on the active therapies—such as stretching, strengthening/pain relief exercises and low-impact aerobic conditioning—that are critical in rehabilitating the lower back and helping prevent or minimize future episodes of low back pain.
Epidural steroid injections for pain
Several common conditions, including a lumbar disc herniation, degenerative disc disease and lumbar spinal stenosis, can cause severe acute or chronic low back pain and/or leg pain. For these and other conditions, a steroid injection may be an effective non-surgical treatment option.
How should patients prepare for the injection?
The week before the injection, patients are not allowed to take any anti-inflammatory medicines or blood thinners. Patients cannot take any aspirin, Plavix, coumadin, Motrin, ibuprofen, naproxen or Aleve. The only anti-inflammatory that is safe is called Celebrex.
Patients will need transportation home from the injection, because it is common for the patient’s leg to feel a little numb, so trying to press on the gas and/or brake may be difficult.
How is the epidural steroid injection performed?
Before the procedure
The procedure usually takes between 15 and 30 minutes. The patient lies flat on an X-ray table on his or her abdomen. Prior to the steroid injection, the skin is numbed with lidocaine, which is like a “local” anesthetic, such as Novocain used by dentists.
Using fluoroscopy (live X-ray) for guidance, the physician directs a needle toward the epidural space. Fluoroscopy is considered important for guiding the needle, because controlled studies have found medication is misplaced in 13 percent to 34 percent of epidural steroid injections that are done without fluoroscopy.
During and after the epidural steroid injection
Once the needle is in the exact position, the epidural steroid solution is injected. Following the spine injection, the patient is usually monitored for 15 to 20 minutes before being discharged to go home.
Patients are usually asked to rest for the remainder of the day. Normal activities may typically be resumed the following day.
What are the benefits of epidural steroid injections?
Patients will find the benefits of an epidural steroid injection include a reduction in pain. Patients also seem to have a better response when the spinal injections are coupled with an organized therapeutic exercise program.
What are the epidural steroid injection success rates?
An injection is generally successful in relieving pain for approximately 50 to 75 percent of patients. It is possible for an epidural to have no effect, last two hours, two days, two months, two years or for the rest of a patient’s life. It is very difficult to predict, but the risk of experiencing side effects from an injection is very unlikely, so the possible positives outweigh the negatives.
If a patient does not experience any back pain or leg pain relief from the first epidural injection, further injections will probably not be needed. However, if there is some improvement in back pain or leg pain, one to two additional epidural steroid injections may be recommended.
What are the risks and side effects of spinal injections?
As with all invasive medical procedures, there are potential risks associated with lumbar (lower back) epidural steroid injections. However, there are few risks associated with epidural steroid injections, and they tend to be rare. Risks may include:
- Infection: Minor infections occur in one to two percent of all injections.
- Bleeding: It is rare and is more common for patients with underlying bleeding disorders.
- Nerve damage: While extremely rare, nerve damage can occur from direct trauma from the needle or secondarily from infection or bleeding.
- Dural puncture: A Dural puncture occurs in 0.5 percent of injections. It may cause a post-Dural puncture headache (also called a spinal headache) that usually gets better within a few days. Although rare, a blood patch may be necessary to alleviate the headache.
- Paralysis is not a risk since there is no spinal cord in the region of a lumbar injection.
There are also potential risks and side effects from the steroid medication, but they tend to be rare. Side effects from steroids are more common when taken daily for several months. They include: a transient decrease in immunity, high blood sugar, stomach ulcers, severe arthritis of the hips, avascular necrosis, cataracts, transient flushing and increased appetite.
How frequently can epidural steroid injections be performed?
There is no definitive research to dictate the frequency of how often a patient should have epidural steroid injections for low back pain and/or leg pain. In general, it is considered reasonable to perform up to three epidural injections per year.
Typically, epidural steroid injections are done in two-week intervals. However, there is no consensus in the medical community for if a series of three injections always needs to be performed. If one or two injections lessen the patient’s low back pain and/or leg pain, some physicians prefer to save the third epidural steroid injection for any potential recurrences of back pain.